Rethink fatigue

Fatigue is the most frequent complaint I hear from my patients and a “pill” that would magically restore their energy level is their number one request. Many of them are healthy and have their hormone balanced, and assert to get enough sleep, eat well and exercise regularly, … what is missing? Let’s step back for a moment and examine “what exactly energy” is.

The word “energy” can mean many things. On the most basic level, it is the power generated in our cells that enables our hearts to beat, our brains to think, and our muscles to move. All of us are producing energy constantly. You couldn’t function if you didn’t. You wouldn’t be able to breathe, get up out of your chair, or read this blog. But that’s not what my patients mean when they talk about energy and fatigue. In an absolute sense, their bodies are producing energy, but they don’t have energy—that is, they don’t have enough physical and/or mental energy to do everything they want with ease.

So, “what determines our energy level”? Like all machinery, the cells of our body must have fuel in order to function properly. This fuel comes from the oxygen we breathe and the food we eat. However, nutrients and oxygen cannot be turned directly into usable energy and the primary source of energy is a molecule called adenosine triphosphate, or ATP.

Our body stores only a small amount of ATP. When demand increases—such as, for example, when we are exercising—our body must churn out more. To do this, it taps into glucose stored in muscles and the liver, as well as fats stored around the body. In our cells, most ATP production take place in an organelle called mitochondria. Our body’s ability to create ATP is crucial because it determines our capacity for physical exertion. A multitude of factors can affect our energy level. But, first, an important biological factor: our genes.

There are probably many genes that play into our energy level. Scientists are only beginning to tease apart what they might be. For example, some people are born with vast amounts of energy: the classic” high-energy type” is someone who need little sleep and is always ready for a social event or a new project. But most people are not so lucky.

Pay attention: just because, for example, your friend has more energy than you do, that doesn’t necessarily mean that there’s something wrong with you. It could simply mean that you are at the lower end of the normal energy spectrum. Apart from genes, there are others factors that influence our energy levels: diet, as seen before, but also exercise, sleep, aging (menopause/andropause), mood, stress, illnesses and medication, all play key roles.

We have already discussed the role of diet. Let’s take a look at how exercise can influence our vigor. It may sound strange, but in order to get more energy, you have to do the very thing you don’t feel you have enough energy to do: exercise. Regular exercise boosts our energy in multiple ways. When you understand how, you will never again think of it as a tedious routine that some health nag wants you to do, but rather as a surefire energy enhancer that you can tap into at will.

There are at least 4 distinct ways that exercise makes us feel more energetic. To begin with, when we engage our muscles in any type of exercise, more energy-producing mitochondria form in our muscle cells. Mitochondria, as said before, are the cellular powerhouses that convert glucose and fat into ATP, the molecule that cells use for energy.

So, while exercise burns energy, it also enables muscle cells to produce more energy. Second, exercise increases our body’s oxygen-carrying capacity. Oxygen, along with glucose and fat, is essential to fueling cells, which need oxygen both to create ATP and to liberate energy stored as ATP. An increase in oxygen therefore gives us more stamina. Any type of regular exercise creates more capillaries, the tiny blood vessels that ferry oxygen to our cells. But aerobic exercise, by making us breathe the most deeply and increasing our heart rate the most, gets more oxygen circulating.

Third, exercise affects levels of various hormones and chemical messengers that can increase energy. When we work out, our body releases epinephrine and norepinephrine. In large amounts, these stress hormones cause the energy-draining fight-or-flight response, but in the modest amounts induced by exercise, they make us feel energized. Exercise also boosts levels of compounds called endorphins, “feel-good” chemicals that lift our mood and are often credited for the “runner’s high.”

An elevated mood in itself can be an energy booster. Finally, regular aerobic exercise almost guarantees that we will sleep more soundly—a prerequisite for feeling refreshed. Exercise is the only proven way to increase the amount of time we spend in deep sleep, the phase of sleep that particularly restores our energy. The more deep sleep we get, the less likely we are to awaken in the middle of the night, and the more rested we’ll feel the next day.

But energy is not just about muscles: it’s also about our mind and emotions. When we’re mentally energetic, we’re curious, we’re alert, we’re “on.” But mental energy is more complicated than physical energy. That’s because the thing that we call “energy” is not simply a reflection of how much ATP our brain cells can generate. It also reflects our emotional state and how interested we are in something.

You may have noticed that when you’re really absorbed in an activity— in a heightened state known as “flow”—you feel more energetic than when you are only half-interested in it. Passion and motivation can be powerful forces in creating energy too. If we are mentally psyched to do something, typically we will feel physically energetic enough to do it. By contrast, if we’re bored, we’re likely to feel a lack of energy.

Bottom line: There is no “pill” that will magically restore the energy of your youth. However, certain lifestyle changes can go a long way toward improving your fatigue. But don’t forget to put some “sparkle” into your lifestyle too!